Physician Compare National (NPI:1972860864)

HEALTHCARE PROVIDER: ANIL RAVI DATE M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1972860864
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4688839582
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140314000939
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DATE
	Individual professional last name
Provider First Name	ANIL
	Individual professional first name
Provider Middle Name	RAVI
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2007
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	GERIATRIC MEDICINE
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GERIATRIC MEDICINE
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	11550 INDIAN HILLS RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 350
	Group Practice or individual's line 2 address
City	MISSION HILLS
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	913451252
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050278
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PROVIDENCE HOLY CROSS MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050624
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	HENRY MAYO NEWHALL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y